MedicaidPrior AuthMedium impact
Kimmtrak (tebentafusp-tebn) (Revised)
Humana·IN · Oncology, Pharmacy·Medicaid
Effective date
Dec 1, 2025
We identified it
Jul 21, 2026
Summary
Humana Medicaid (Indiana) requires prior authorization for Kimmtrak (tebentafusp-tebn) in metastatic uveal melanoma treatment. Billing teams must verify three approval criteria before claims submission: unresectable/metastatic uveal melanoma diagnosis, HLA-A*02:01-positive disease documentation, and monotherapy use. Claims will be denied without prior authorization and documented compliance with all criteria.
Action Required
By December 1, 2025: Billing team must implement prior authorization requirements for all Kimmtrak (tebentafusp-tebn) claims submitted to Humana Medicaid Indiana. (1) Update billing software to flag all Kimmtrak prescriptions for mandatory prior auth before claim submission. (2) Create or update clinical documentation checklist in EMR requiring: diagnosis of unresectable or metastatic uveal melanoma, HLA-A*02:01 assay results documentation, and confirmation of monotherapy use. (3) Train billing and clinical staff that claims lacking these three elements or showing prior disease progression on Kimmtrak will be denied. (4) Notify oncology providers to include HLA testing results and treatment plan documentation with all Kimmtrak requests. (5) Refer to Humana's PAL (Preauthorization and Notification List) at www.humana.com/PAL for current medical and procedural coding information. Failure to obtain prior authorization will result in claim denials.